In general, we purchase a health insurance policy so that it can cover our back financially when we need the money. But in a few cases, health insurance claims can be denied in different cases. If you have received a service already and the insurer now refuses to pay for this, then it is called a claim denial. An insurer may refuse to accept the claim during the pre-authorization process which is called pre-authorization denial. If you face this type of situation, you may be able to appeal again and may agree with the health insurance company to pay for your services.
Why Are Health Insurance Claims Denied?
1. Data Errors
One of the most common reasons behind claims being denied is data errors. Many times the provider may misspell your name, enter the wrong birth date or leave out some information. If the claim gets denied, then check the information first. If you find anything wrong, then let the provider know and resubmit the claim.
2. Choose the Insurer Carefully
There are a few procedures such as MRI, CT scan which require pre-authorization. Your claim may be denied as it wasn’t pre-authorized. Therefore, you have to talk to the doctor who ordered the procedure. The expert can show patient records that can determine that you needed the service. But still, if you get denied, then you should choose a different healthcare provider.
What Can You Do After Getting a Health Insurance Claim Denied?
1. Have to Read the Policy Very Carefully
You have to figure out why your claim gets denied. There is a possibility that the health insurance company interprets the clause in another meaning but you have understood it totally differently. You have to contact the insurer to get an explanation of the denial so that you can know what to do to move forward.
2. Appeal the Denial Again
You can appeal any denial under the Affordable Care Act. If the insurance company refuses your claim again, then you can also go for an external independent appeal. It can be applicable for both post- and pre-service denials. If you want to get pre-authorization for care but the insurance company refuses it, then you can appeal for it again.
Stay Protected
Many people think there is no need to purchase a health insurance policy as they cannot get any profit in return for years. But profit is not only connected to our money but also our health. It’s time we have to remember once again that health is wealth. So, if you want to get a proper insurance policy for the safety of your family, call Oklahoma Health Options in Edmond, OK.
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